Provider Demographics
NPI:1588303457
Name:LITWICKI, THOMAS ROBERT JR (BCBA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROBERT
Last Name:LITWICKI
Suffix:JR
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 W DRAGOON TRL
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-4713
Mailing Address - Country:US
Mailing Address - Phone:574-314-0843
Mailing Address - Fax:574-635-3201
Practice Address - Street 1:1316 W DRAGOON TRL
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-4713
Practice Address - Country:US
Practice Address - Phone:574-314-0843
Practice Address - Fax:574-635-3201
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-22-59699103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst